Testing for Fertility: 10 Areas for Investigation

Over the last few months I have written a series of articles looking at fertility and how naturopathic medicine can help improve your reproductive health. This week I want to look at the tests we can do to establish if there are any problems and what we can do about them in order to improve your chances of conceiving. If you have missed any of the previous articles in this series and would like to catch up, you can read the following:

Sowing a Seed: Improving Fertility with Seeds and OilFertility & Folic Acid: Why Taking Folic Acid May Not Be EnoughWanting To Get Pregnant? Don’t Forget About Sperm HealthWhat Is PCOS And How Does It Affect My Fertility?Is An Underactive Thyroid Preventing You Getting Pregnant?How Stress Affects Fertility

There are many factors involved in infertility, for both men and women and, in this week’s article, I will review the key tests that can help us determine the state of your fertility and understand how we can improve it. Ideally, you will do these tests prior to starting to try to get pregnant but you should certainly consider them if you’ve been trying for a while with no success.

If you are thinking about getting pregnant, there are some basic tests you can do to help get yourself to optimum health. If you are one of those women who decided to start trying and managed to get pregnant on the first or second month then doing a lot of testing will not be necessary. However, there is a large population of women for whom getting pregnant does not come easily or who have been previously diagnosed with polycystic ovarian syndrome (pcos), endometriosis, food allergies or any chronic health condition. If you fall into either of these categories then you may find these tests useful.

Note: Some can only be done at certain times in the menstrual cycle, while others can be done at any time; I have indicated where there are specific timings that need to be adhered to.

Category 1: STD testing

Why?Some STDs are asymptomatic and a simple test can be done to check for them. If you have not had a full sexually transmitted disease panel test in many years it will be worth doing one now. The purpose is not to check if your partner has been unfaithful, but to make sure the mother does not have an STD she doesn’t know about that could either affect trying to get pregnant or the baby. For example, genital herpes in the mother can be dangerous if the baby comes in contact with active lesions. However, the mother may have been exposed years ago and may have never had an outbreak until pregnancy.

Who?Women and men

When?Before trying to conceive if labs have not been done since your last sexual partner. Even if you are married and it has been a few years since you were last tested, it is always a good idea to have this test before trying to get pregnant.

Category 2: Pap Smear

Why?An abnormal pap can be a precursor to cervical cancer and it’s important to take care of this before getting pregnant. For this reason a pap smear is recommended prior to starting to try get pregnant.

Who?Women

When?Every two years if no change in sexual partner, and before conception

Category 3: Blood Work

Why?I check the fasting blood work of all of my patients as it gives a good indication of their overall health and allows us to pick up on any problems. Normally we check:

CholesterolThis is the backbone for all of our steroid hormones so healthy amounts are crucial for hormone production in women. Cholesterol levels that are too low or too high are associated with a number of different health concerns.

GlucoseTo find out about your diabetes risk

General chemistryTo tell us about the general health of your body

Hemoglobin A1CThis also tells us about your risk for diabetes

Vitamin DThis tells us about your bone health and hormonal health

Kidney function

Liver function

Who?Men and women

When?Annually and before conception

Category 4: Autoimmune Testing

Why?The reason this is important is that autoimmune disease may be asymptomatic but it can affect your fertility. From a Naturopathic point of view, knowing whether you carry these markers affects your pre-conception care. I do this as yearly testing for my patients but most people will have to ask their physician to run the following autoimmune tests:

Anti-nuclear antibody (ANA)If this marker is positive we need to investigate further to ascertain what type of autoimmune condition is indicated. The most common conditions are lupus, sjogrens and mixed connective tissue autoimmune.

Rheumatoid arthritis (RA)Rheumatoid arthritis is an autoimmune condition that attacks the joints; it can also affect fertility.

Thyroid Auto-antibodiesThese tests are different than hormone testing. They check to see if your immune system is attacking your thyroid gland. These tests are looking for anti-TPO and anti-thyroglobulin antibodies but please note, you could be producing these auto-antibodies and still have “normal thyroid values”. Both these tests can be included in your bloodwork (see above).

Who?Men and womenWhen?Before conception, and periodically over the years, as an autoimmune condition can begin at any time.

Category 5: Food Sensitivity Testing

Why?Food sensitivity tests look for delayed food sensitivities which can create low level of inflammation in the body. To find out more you can refer to my article on food allergies as a cause of infertility, but here are the most common reasons that food sensitives affect fertility:

Cervical mucusFood sensitives can change the quality of the cervical mucus.

Prolactin hormoneProduced in the pituitary gland, prolactin plays an important role in ovulation. Elevated levels of prolactin are associated with sensitivity to gluten.

Immune ReactionsIncreased toxins and inflammation as a result of immune system reactions affect ovulation and can exacerbate menstrual cycle disorders.

Chronic DiarrheaDiarrhea as a result of food sensitivities can affect the absorption of nutrients and lead to deficiencies that can lead to problems with ovulation and menstrual disorders

I recommend doing an IgG food allergy blood test before trying to conceive to see whether you have any food sensitivities that could be having an impact on your fertility.

Who?Men and Women

When?At any time either before conception or if you have difficulty conceiving.

Category 6: Genetic Testing for Methylation Defects

Why?There are two main genes we want to look out for – MTHFR C677T and MTHFR A1298C. These genes are important for the role they play in converting folic acid into its active form, 5-MTHFR. This active form is needed for DNA production which occurs at a rapid rate in the fetus following conception. Knowing if either parent carries one of these genetic defects allows for proper supplement treatment and improved fertility and pregnancy outcomes.

The best way to do this test is to order a genetic test kit from 23 & Me. It is a spit test and, once done, you mail your sample back to the lab and your results will be emailed to you.

Who?Men and women

When?Before trying to conceive

Category 7: Salivary Cortisol Test

Why?It is well known that being stressed can undermine the ability to fall pregnant, this test tells us how stressed you are and how well your body is dealing with it. It tells us this by measuring your levels of cortisol (the stress hormone) throughout the day. The adrenal glands produce cortisol in response to stress and cortisol levels should be at their highest in the morning and lowest in the evening. What the practitioner is looking for is how much stress your body is under and how healthy your adrenal glands are. Improving adrenal health improves fertility. You can read more about this here.

Who?Men and women

When?Before trying to conceive

Category 8: Hormone Testing

Why?Getting pregnant is entirely dependent on both parents producing the right hormones at the right time in the right quantities. Testing the following hormones is therefore crucial to understanding the state of your fertility as a couple:

Follicle Stimulating Hormone (FSH)Who?

Women

When?Day 2 or 3 of your cycle

Lutenizing Hormone (LH)Who?Women

When?Day 2 or 3 of your cycle (day 1 being the first day you bleed). Luteinizing hormone surges in the middle of your menstrual cycle – in the mid-luteal phase – so you may need to test again about seven days after you begin ovulating. After ovulation, your doctor may recheck your estradiol and progesterone levels and compare them with the levels taken on day two or three of your cycle.

EstradiolWho?Women

When?Day 3 of your menstrual cycle. This may also be checked again after ovulation.

ProgesteroneWho?Women

When?Best checked as pooled levels – 3 blood draws taken over one week starting 4 days post-ovulation. The three levels are then added together.

ProlactinWho?Women

When?Elevated levels of prolactin inhibit ovulation. This can be high if breastfeeding or possibly if there is a problem with the pituitary gland in the brain. This can be tested either in preconception screening if you have a history of irregular menstrual cycles or after 6 months of trying to conceive with no success.

ThyroidIt is important to check not only for thyroid stimulating hormone (TSH) but also the thyroid hormones, free T3 & T4, and the thyroid autoantibodies, anti-TPO and anti-thyroglobulin.

Who?Women and men

When?Before trying to conceive and annually

TestosteroneThis hormone means different things for men and women. If the woman has elevated testosterone then she could have polycystic ovarian syndrome (PCOS). If the male has too little testosterone then his sperm production and its quality can be affected.

Who?Women and men

When?Before trying to conceive. This test can be included in your annual blood work.

DHEASThis is an adrenal hormone that is important for egg quality and adrenal health. It is also a precursor to testosterone so it’s important to test men as well as women for testosterone and sperm levels.

Who?Women and men

When?Before trying to conceive. DHEAS can also be tested when doing the salivary test for cortisol.

The following tests may be added if conception has not occurred within 6 months of trying to conceive.

Category 9: Anatomical & Structural Testing

You do not generally need to do all 3 of these tests; usually your physician will recommend one of them.

HysterosalpingogramThis is an x-ray that looks at the inside of the uterus and the fallopian tubes and the area around them. A dye or contrast material is injected into the uterus where it travels into the fallopian tubes. Pictures are taken using a steady beam of x-ray as the dye passes through the uterus and fallopian tubes. The imaging shows problems such as an injury or abnormal structure such as blockages in the fallopian tube that could prevent sperm from moving into the tube to fertilize an egg. Abnormalities in the uterus can also be detected. This procedure is known to “clear out the cobwebs” and open up and clear slight adhesions in the fallopian tubes that may have been inhibiting fertility.

Who?Women

When?Between days 6 and 13 of your cycle

HysteroscopyIf a problem is found in the HSG, your doctor might order a hysteroscopy. In this procedure, a thin telescope-like instrument is inserted through the cervix into the uterus to allow the doctor to see and photograph the area to look for problems.

Who?Women

When?Usually between days 6 and 13 of your cycle but this could vary based on the information needed by your physician.

UltrasoundThis test helps determine whether the follicles in the ovaries are working normally and if there are any fibroids or polyps on uterine lining. It can also tell the thickness of the uterine lining; if the lining is too thin it could indicate low estrogen levels that can be fixed with hormone supplementation. However, if the uterine lining is too thick, or there is extra tissue growth such as fibroids or polyps, this can indicate too much estrogen and will need a different treatment approach.

Who?Women

When?Days 7-18 of your menstrual cycle.

Category 10: Male Semen analysis

This test may not need to be done immediately but I would recommend you have it done after 6 months of trying to conceive, especially if you have been taking the healthy sperm supplements. I strongly recommend that men start making the diet and lifestyle adjustments needed prior to trying to conceive. To read more about male fertility, click here.

Who?Men

When?After trying to conceive for 6 months with no success

Closing Thoughts

In conclusion, there are some lab tests mentioned above that need to be checked yearly regardless of whether or not you are trying to conceive. There are also some tests that may need to only be done once, like genetic testing or a hysterosalpingogram while others will need to be run periodically while you are trying to conceive. As I have said before, healthy bodies make healthy babies and using the right tests at the right time can guide us towards improving our health.

Improving fertility based on the results of testing may involve a simple modification in lifestyle or may require adding hormones or even a possible surgical procedure. As some tests can only be done at certain times of your monthly cycle then many months can go by before all the tests are completed, especially if your cycle is between 28 and 34 days. This is why I like to review the testing options early with my patients. It means they can be well-informed about their fertility options and how long any testing might take.

If you have any further questions or would like to schedule an appointment to discuss your fertility with me, you can find out more at http://apathtonaturalhealth.com/.

I blog about all aspects of naturopathic health so please, keep an eye out for future articles. If you want to be sure not to miss anything, you can even subscribe so you receive all new articles direct to your inbox.

Dr. Maura Scanlan discusses “small intestinal bacterial overgrowth” (SIBO): what it is, what causes it, how to recognize the symptoms, and how to treat it. Part 2 of a series on digestive health.

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